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Stanford Report, January 29, 2003

Lecture explores link between cholesterol levels, heart disease and diabetes

By AMY ADAMS

Weight and cholesterol levels could be used to identify patients whose risk of heart disease and diabetes would drop most after shedding a few pounds. These findings were presented by Gerald Reaven, MD, in a grand rounds lecture Thursday.

Reaven, professor of medicine, emeritus, said the key to obesity-related disease is insulin. "There is enormous variability in the world at large in terms of how effectively people use insulin," he said.

Insulin is a hormone that helps cells in the body absorb sugar after a meal. People who are less sensitive to insulin tend to make more of the hormone after a meal to keep blood sugar levels in check. These people are most likely to develop diabetes and to have heart disease.

Reaven found that overweight people who lost weight had less heart disease than similarly overweight people who did not lose weight and that the slimmer patients become more sensitive to insulin. When he broke these patients into groups according to their insulin sensitivity before losing weight, he found that the most insulin-resistant people also had the most heart disease. Those insulin-resistant people who lost weight had the sharpest drop in heart disease risk.

The problem for doctors is identifying insulin-resistant people who would most benefit from a prod toward weight loss. The test to measure insulin levels is inaccurate and costly, Reaven said. As a stand-in for directly measuring insulin, Reaven found that 92 percent of high-risk people also had high body weight and cholesterol levels.

"This provides one approach to identify those who you should focus your efforts on trying to get to lose weight," Reaven told his audience of doctors.

Reaven added that in his studies people lost weight equally well on all low-calorie diets and found that insulin-resistant and insulin-sensitive people had equal success in shedding the unwanted pounds.